Corporate - SCALA

Corporate Membership Application

If a corporation that has a total of 150 or more beds & wishes to join and pay for all of their SC facilities at one time, they may pay. $18 Per Bed For All Facilities

Company/Organization Name*
Username*
Password
Enter Password Confirm Password
First Name*
Last Name*
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
Please complete this section if provider
Total # of licensed beds*
Please enter a number greater than or equal to 150.
Date of last DHEC Inspection
MM slash DD slash YYYY
Type of Ownership
Do you accept Medicaid?
- Yes
- No
Operations Director/Regional Director
Email
I (we) hereby submit the information above for the consideration of the Membership Committee and/or theBoard of Directors and apply for membership with the SC Assisted Living Association. I (we)agree to comply with all rules and regulations as set forth by SCALA standards including the bylaws and Code of Ethics. Please submit method of payment at time of application and payment will only be processed after approval for membership. Membership will be reviewed and an answer will be given within seven (7) days of submission. Please note 25% of SCALA dues are allocated for lobbying, consulting & legislative efforts and are not allowable as a business expense.
Signature of Approval*
Date*
MM slash DD slash YYYY
Payment
Corporate Membership
Price: $0.00
Total
$0.00
Already active? Enter the registration key.
Payment Method*

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
Comments
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Corporate Membership Application

Please complete this section if provider

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